14例产科弥散性血管内凝血诊治分析及Takao产科DIC评分系统应用探讨

To analyze the diagnosis and treatment for 14 disseminated intravascular coagulation obstetrical patients and to discuss the application of Takao obstetrical DIC score in pregnant women

目的:分析产科弥散性血管内凝血(DIC)的病因、诊断、治疗及结局,探讨Takao产科DIC评分系统在诊断产科DIC中的临床价值。方法:回顾分析2015年1月至2017年12月华中科技大学同济医学院附属同济医院产科收治的14例DIC患者的临床资料,并运用评分系统进行动态评分。结果:产科DIC的发病原因包括产后出血6例(6/14),胎盘早剥5例(5/14),羊水栓塞2例(2/14),急性胰腺炎1例(1/14)。运用Takao产科DIC评分系统评分,得分5～22分。达到DIC诊断标准(≥8分)者10例,5例(5/14)在完成第一阶段治疗后DIC得到纠正。运用国际血栓和止血协会(ISTH)评分系统评分,得分3～8分,达到DIC诊断标准(≥5分)者10例,11例(11/14)完成第一阶段治疗后DIC得到纠正。根据两种评分系统,完成第二阶段治疗后,均余1例患者DIC未能纠正。根据Takao产科DIC评分系统疗效评估标准,第一阶段治疗结束时疗效为显效2例,良好5例,一般3例,恶化4例;完成第二阶段治疗时显效6例,良好5例,一般3例。13例患者经积极治疗后纠正DIC,1例因多器官功能衰竭,抢救无效死亡。结论:产科DIC病情凶险,早期明确诊断、积极治疗是挽救孕产妇生命的关键。建立完善的评分体系对于尽早准确诊断病情、指导治疗有重要意义。

Objective： To analyze the etiology,diagnosis,treatment and clinical outcome of obstetrical DIC,and to discuss the clinical value of the Takao obstetrical DIC score systems.Methods： To analyze the 14 patients who were admitted in Tongji Hospital from Jan. 2015 to Dec.2017 respectively,and to use the DIC score to estimate the patients＇ condition dynamically.Results： The etiology of obstetrical DIC included postpartum haemorrhage（ 6/14）,placenta abruption（ 5/14）,amnionic fluid embolism（ 2/14） and acute pancreatitis（ 1/14）.All these 14 patients were scored by the both score systems.The score was from 5 to 22 points by the Takao obstetrical DIC score,and no less than 8 in 10 cases.5 patients were effectively cured from DIC when the first phase therapy was finished.The score was from 3 to 8 points by ISTH DIC score system,and no less than 5 in 10 cases.11 patients were effectively cured from DIC when the first phase therapy was finished.After the second phase therapy finished,only one patient was still in the DIC status by both score systems. The therapeutic efficacy was considered 2 excellent,5 good,3 fair and 4 aggravated when the first phase therapy was completed,and 6 excellent,5 good,3 fair when the second phase therapy was completed.In the end,13 patients were cured,only 1 patient died for MODS.Conclusion： The obstetrical DIC presents a threatened condition,early diagnosis and active treatment is essential for saving the lives of pregnant women.It could be contained an important clinical significance if the complete score standard was set up.